From the Department of Sexual and Reproductive Health, Guy's and St Thomas' NHS Foundation Trust, London.
Department of Sexual Health/HIV Medicine, Western Health & Social Care Trust, Derry, Northern Ireland, United Kingdom.
Sex Transm Dis. 2024 Jul 1;51(7):504-507. doi: 10.1097/OLQ.0000000000001963. Epub 2024 Mar 6.
Lymphogranuloma venereum (LGV) remains endemic in the United Kingdom, primarily among gay, bisexual or other men who have sex with men (GBMSM). Current treatment guidelines recommend 21 days of doxycycline, but recent evidence suggests shorter antibiotic duration is as effective. We evaluated clinical outcomes in a cohort with LGV treated with 7 days of doxycycline.
We reviewed case notes of all LGV cases at a South London sexual health service between November 2016 and September 2022, treated with only 7 days of doxycycline and anonymized data were collected from electronic patient records.
Fifty-two individuals with detected LGV-specific DNA were treated with 7 days of doxycycline 100 mg twice daily. All were GBMSM, median age of 35 years (range, 21-64 years), 21 (40%) were living with HIV, and 18 (35%) had concomitant sexually transmitted infections. Thirty-four (65%) were asymptomatic, whereas 18 (35%) reported symptoms: 7 (13%) urethral, 11 (21%) anorectal, and 2 (4%) other symptoms. Twenty-two (42%) were prescribed additional antimicrobials; however, none were active against Chlamydia trachomatis . All 52 underwent follow-up testing (range, 4-481 days). Chlamydia trachomatis was detected in one individual, but negative for LGV-specific DNA, and so considered to be a reinfection. All other cases were C. trachomatis -negative, indicating successful LGV eradication.
Our data support the approach of offering a 7-day doxycycline course routinely for asymptomatic or clinically mild C. trachomatis infections, and contacts of LGV infection, regardless of their LGV status. This may simplify patient management, reduce cost, and improve antimicrobial stewardship.
淋球菌肉芽肿（LGV）在英国仍呈地方性流行，主要发生于男同性恋、双性恋或其他与男性发生性关系的男性（GBMSM）中。目前的治疗指南建议使用多西环素 21 天，但最近的证据表明较短的抗生素疗程同样有效。我们评估了在伦敦南部性健康服务中心接受 7 天多西环素治疗的 LGV 患者队列的临床结局。
我们回顾了 2016 年 11 月至 2022 年 9 月期间在伦敦南部性健康服务中心接受仅 7 天多西环素治疗的所有 LGV 病例的病历，并从电子患者记录中收集了匿名数据。
52 例检测到 LGV 特异性 DNA 的个体接受了 7 天的多西环素 100mg 每日两次治疗。所有患者均为 GBMSM，中位年龄 35 岁（范围，21-64 岁），21 例（40%）合并 HIV 感染，18 例（35%）合并性传播感染。34 例（65%）无症状，18 例（35%）有症状：7 例（13%）尿道，11 例（21%）肛门直肠，2 例（4%）其他症状。22 例（42%）同时开具了其他抗生素，但均无针对沙眼衣原体的活性。所有 52 例患者均接受了随访检查（范围，4-481 天）。1 例患者检测到沙眼衣原体，但 LGV 特异性 DNA 检测为阴性，因此被认为是再感染。其他所有病例均为沙眼衣原体阴性，表明 LGV 已成功清除。
我们的数据支持对无症状或临床轻度沙眼衣原体感染以及 LGV 感染者的接触者常规提供 7 天多西环素疗程的方法，无论其 LGV 状态如何。这可能简化患者管理，降低成本，并改善抗菌药物管理。
